How Western DRC’s Ebola Outbreak Was Contained

The Ebola outbreak in Congo has been closely tracked and, so far, well-contained, in stark contrast to the 2014 West Africa outbreak that killed thousands of people.

The Ebola outbreak in the Democratic Republic of the Congo appears to be in its waning days. Despite 28 deaths as of early June, health officials are cautiously optimistic that they are bringing the outbreak under control. So far, it’s a striking turnaround from the 2014 West Africa outbreak, which killed more than 11,000 people in Liberia, Sierra Leone and Guinea, and traveled as far as Glasgow, Scotland, and Dallas, Texas.

Despite difficult-to-traverse terrain and local communities’ skepticism of health care workers, from the start of the outbreak, officials got in front of the disease and kept it in check. Several factors made the DRC response markedly different than previous outbreaks, saving countless lives.

1. Long distances between villages and an underdeveloped infrastructure slowed the spread of the disease.

The DRC’s remoteness made it difficult for health care workers to access affected communities, but it also impeded the spread of the disease. For the most part, infected individuals did not leave their communities, and outsiders didn’t come in, greatly limiting the number of infections. In contrast, in 2014, at the height of the West Africa epidemic, Ebola spread quickly through densely populated cities.

“The risk zero doesn’t exist. That is what we need to have all in mind. The risk for the virus to escape to neighboring countries is there. But with the actions — the strong actions that the government is taking now — it can limit the spread of this disease, first of all in the Congo itself, and in neighboring countries.”

Djoudalbaye BenjaminHead of Policy and Health Diplomacy, Africa Centres for Disease Control and Prevention

The Democratic Republic of the Congo is Africa’s second-largest country by land area, and the fourth-most populous. It has also faced more Ebola outbreaks than any other country. The 2018 outbreak is the seventh major outbreak in the DRC’s history, according to the World Health Organization. The virus was first identified there in 1976. (VOA)

2. A highly effective vaccine, in development for more than a decade but not made available until the end of the West Africa outbreak, was deployed almost immediately in the DRC.

The vaccine, V920, though still experimental, has proved highly effective in preventing the transmission of Ebola. It’s difficult to transport and available in limited quantities. But health care officials have found workarounds.

“The vaccine is a live-virus vaccine. It has just one little piece of Ebola virus but the surface protein that coats the surface of Ebola virus, expressed in the backbone of a harmless virus. And so it replicates in the body and induces an immune response — things like antibodies that we believe are protective.”

They ship the drug in specialized containers that keep the temperature below the required -60 degree Celsius threshold. And they administer it using the “ring vaccination” approach, which involves targeting individuals most likely to come in contact with infected patients.

In this photo taken Thursday, May 31, 2018, a World Health Organization staffer holds a used vial of Ebola vaccine in Mbandaka, Congo. For the first time since the Ebola virus was identified more than 40 years ago, a vaccine has been dispatched to front-line health workers in an attempt to combat the epidemic from the onset. (AP Photo/Sam Mednick)

3. Local communities have been receptive to health care interventions.

Residents have questioned health care workers’ intentions, the efficacy of the experimental vaccine and even whether Ebola is real. Despite these misgivings, affected communities have been receptive to being vaccinated.

“As you can imagine, having Ebola virus existent in a community is a cause of concern for the local population. And that's why it was important, really, to have teams of social mobilizers and anthropologists who are being deployed to make sure that everything is explained to the communities.”

Tarik JasarevicWorld Health Organization Spokesperson

As of June 10, 2,295 people have been vaccinated in Wangata, Iboko and Bikoro. Those vaccinated include front-line health workers, along with people exposed to individuals with confirmed cases of Ebola, and their contacts.

Officials have engaged in a multipronged awareness campaign, including mass media, training for local journalists and meetings with local leaders, the WHO said.

In this photo taken Friday, June 1, 2018, a family sits outside in a neighborhood where three people died of Ebola last month, in Mbandaka, Congo. For the first time since the Ebola virus was identified more than 40 years ago, a vaccine has been dispatched to front-line health workers in an attempt to combat the epidemic from the onset. (AP Photo/Sam Mednick)

4. An improved international infrastructure to respond to disease outbreaks proved effective.

When Ebola struck West Africa from late 2013 to early 2016, the continent had no central body to help prevent, track and manage emergency responses to infectious diseases. That changed in January 2017, with the launch of the Africa Centres for Disease Control.

“We have put in place the ability to pick up public health threats much more quickly and then to respond in a very timely and robust manner. And that's the biggest change that we've seen this time round. We've deployed, as I said, more than 150 people within 10 days of this outbreak being confirmed. And we've had tremendous support, I must say, from our partners. Whether it's Médecins Sans Frontières, The World Food Programme, UNICEF or the Red Cross and Red Crescent, we've had a lot of support from partners to make sure everything is extremely well functioning in this response.”

As part of the African Union, the Africa CDC aims to improve the continent’s public health infrastructure. In the DRC, that has involved providing support to national efforts via an emergency operation center, deploying an epidemic response team and earmarking $250,000 to help fund the response.

Congo’s remote landscape and poor infrastructure have challenged health care workers trying to reach affected communities. Out-of-date census information and inaccurate maps have further complicated the response because officials rely on accurate data to understand the lifecycle of an outbreak.

The Democratic Republic of the Congo is Africa’s second-largest country by land area. The 2018 outbreak has affected three regions in the remote western part of the country, near the border with the Republic of Congo.

That’s prompted experts such as Cyrus Sinai, a UCLA cartographer, to get involved.

Sinai worked with the Ministry of Health, The Atlantic reported, to update old, inaccurate maps and conduct a “microcensus” to estimate population sizes.

Plans are also underway to build a continent-wide database. That would help in capturing information to aid future outbreak response efforts.

About the Project

“How Western DRC’s Ebola Outbreak Was Contained” draws on reporting from The Voice of America‘s Africa Division, and beyond, to highlight efforts to fight the 2018 Ebola outbreak in Congo. VOA‘s Africa Division covers the continent with original reporting and programming in 15 languages.

About the Author

Salem Solomon is a multimedia digital journalist with the Voice of America’s Africa Division. Her award-winning multimedia projects and daily reporting focus on stories across Africa. For tips and inquiries, contact her at salemsolomon@voanews.com or @Salem_Solomon.